Retooling for an Aging America Building the Health Care Workforce (2008) / Chapter Skim
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1 Introduction
1 Introduction
Pages 15-38
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From page 15... ...
While this report builds on other IOM studies on health care quality and the workforce, it is unique in that it defines the health care workforce broadly, including consideration of both the professional and direct-care workforces, as well as the roles of informal caregivers and patients. The next generation of older adults will be like no other before it.
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From page 16... ...
The major reason for the growing number of older adults in the United States will be the aging of the baby boom generation, but increased longevity will also contribute. During the lifetime of the baby boomers, there has been a variety of improvements in personal health behaviors (e.g., smoking cessation)
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From page 17... ...
These high rates of health service utilization coupled with the large rise in the number of older adults can be expected to result in a dramatic increase in the demand for health and long-term care services in the coming decades. This escalation in demand for health care services will in turn create a number of challenges that will need to be addressed, including inadequate numbers of health care workers, the limited training of those workers in geriatric skills, the misalignment of the payment system, and scarce financial resources.
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, and the dominant providers of long-term care services are families and friends, referred to as informal caregivers (also known as unpaid or family caregivers) (Johnson and Wiener, 2006)
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. In 1987, the National Institute on Aging predicted a need for 60,000 to 70,000 geriatric social workers, but today we still only have about one-third of that number (NIA, 1987)
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Box 1-1 highlights just a few of the current and future shortages. Discussions of health care workforce shortages often focus solely on professionals, but direct-care workers (i.e., nursing assistants, home health aides, and personal- and home-care aides)
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Only 4 percent of social workers and less than 1 percent of physician assistants identify themselves as specializing in geriatrics (AAPA, 2007; Center for Health Workforce Studies, 2006)
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Federal requirements for training do exist for some types of direct-care workers, but they tend to be minimal. For example, home health aides and certified nurse assistants employed by nursing homes or home health agencies must have 75 hours of training (PHI, 2003b)
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From page 23... ...
While states are working to expand home- and community-based long-term care services, a bias remains toward institutional settings, especially nursing homes (Wiener, 2007)
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As state Medicaid spending rises, it competes with investments in other areas, such as education and transportation. Future Medicare and Medicaid policy cannot be predicted, but financial TABLE 1-2 Intermediate Projections for the Medicare Program, 2007, 2016, and 2030 2007 2016 2030 Medicare enrollment 44 million 55 million 79 million Medicare expenditures $438 billion $863 billion NA HI trust fund assets $305 billion $221 billion $0 Medicare spending as a percentage of gross 3.2% 3.9% 6.5% domestic product (2015)
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From page 25... ...
. To address this charge, the committee sought to describe promising models of health care delivery and the workforce that will be necessary in the future to serve the medically indicated, culturally conditioned, and satisfiable health care needs of the population of older adults, recognizing that any or all of these needs may be modified.
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What is the projected future health status and health care services utilization of older Americans?
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The committee defined the health care workforce broadly to encompass all personnel involved in the delivery of health care services, including health care professionals (physicians, nurses, physician assistants, social workers, oral-health care workers, pharmacists, allied health care workers, and so on) , and direct-care workers (e.g., nurse aides, home health aides, and personal- and home-care aides)
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From page 28... ...
In the context of health care services for older adults, however, "need" is understood to be "clinical need," which is what a medical or social services professional believes is appropriate care for an individual, given his or her medical condition. And since the public and private third-party payment system uses "clinical need" to determine which services will be paid for, in practice the distinction between demand and clinical need is much smaller.
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From page 29... ...
Hartford Foundation established centers of excellence in geriatric medicine and geriatric psychiatry based on recommendations from a 1987 IOM report, Academic Geriatrics for the Year 2000 (Rowe et al., 1987) , and that foundation also devotes significant financial and career support for geriatric nursing and social work (Warshaw and Bragg, 2003)
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From page 30... ...
The nation is responsible for ensuring that older adults will be cared for by a health care workforce prepared to provide high-quality care. If current Medicare and Medicaid policies and workforce trends continue, the nation will fail to meet this responsibility.
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Baby boomers differ from preceding generations with respect to levels of education, wealth, and their access to health care services. These factors may yield a generation of older adults whose demand for health care resources differs from their parents.
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Chapter 6 discusses the role that informal caregivers play in providing direct-care services to older adults. These individuals are integral members of the patient's overall care team.
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2002. Chronic conditions: Making the case for ongoing care.
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2003. The future supply of long-term care workers in relation to the aging baby boom generation.
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2007. Meeting the long-term care needs of the baby boomers: How changing families will affect paid helpers and institutions.
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2003b. Training quality home care workers.
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2005. Direct care workers in long-term care.
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